The Supreme Court of Florida (“Florida Supreme Court”) held in its opinion filed on December 20, 2018: “Our medical malpractice jurisprudence makes clear that a physician may be the proximate cause of a patient’s injury even if that physician is not the primary cause of that injury … the law does not require an act to be the exclusive or even the primary cause of an injury in order for that act to be considered the proximate cause of the injury: rather, it need only be a substantial cause of the injury.”
In the case the Florida Supreme Court was deciding, the plaintiff was diagnosed with a cancerous tumor in the back of her head that a neurosurgeon diagnosed as an osteosarcoma, without performing a biopsy. The defendant neurosurgeon scheduled the decedent for surgery to remove the tumor.
The pre-surgery medical clearance examination by the decedent’s primary care physician included an EKG that the EKG machine flagged as abnormal, indicating that the decedent’s heart may have been enlarged and that she may also have suffered two myocardial infarctions. Additionally, the second page of the decedent’s urinalysis results indicated the abnormal presence of protein in her urine (proteinuria). Despite these abnormal test results, the decedent’s primary care physician cleared her for surgery.
The defendant anesthesiologist, who interviewed the decedent just before she had surgery, did not advise the defendant neurosurgeon regarding the abnormal tests results before the surgery. The defendant anesthesiologist signed the pre-anesthesia form and cleared the decedent for surgery.
During the surgery, the decedent lost a large amount of blood and ultimately died. An autopsy was performed and a pathology test of the tumor tissue revealed that, rather than being an osteosarcoma, the decedent’s tumor was caused by a type of plasma cell cancer known as multiple myeloma, for which surgery was contraindicated.
The Florida medical malpractice wrongful death lawsuit alleged that had the decedent been correctly diagnosed, the surgery would have been canceled and the decedent would have survived. With regard to the defendant anesthesiologist, the plaintiff alleged that he breached the standard of care by (1) not reviewing all the available data in the decedent’s chart, (2) not ordering a second EKG to reconcile the abnormal results of the first EKG, and (3) not reporting the abnormal lab results—some of which he did not review—to the decedents’ surgeons. The plaintiff contended that if the defendant anesthesiologist had adhered to the standard of care, either he or the surgeons would have realized the decedent was suffering from multiple myeloma and the surgery would have been canceled.
The trial court granted a directed verdict in favor of the defendant anesthesiologist, holding that, even assuming he was negligent in his care of the decedent, he did nothing more than place her in a position to be injured by the independent actions of third parties—namely, the surgeons.
The Florida Supreme Court stated that the issue was whether there was competent, substantial evidence in the record which would permit a reasonable factfinder to conclude that the defendant anesthesiologist, more likely than not, proximately caused the decedent’s death. The Florida Supreme Court stated that in determining whether a defendant’s conduct proximately caused a plaintiff’s injury, courts analyze whether said injury, given actual causation, was a foreseeable consequence of the danger created by the defendant’s negligent act or omission. Merely furnishing the occasion for a person to be injured by the supervening negligence of a third party is ordinarily not sufficient to establish proximate cause. Instead, the injured party must show that the alleged tortfeasor substantially caused the specific injury that actually occurred. A harm is ‘proximate’ in a legal sense if prudent human foresight would lead one to expect that similar harm is likely to be substantially caused by the specific act or omission in question. The question of foreseeability as it relates to proximate causation generally must be left to the factfinder to resolve.
The Florida Supreme Court stated that the law does not require an act to be the exclusive or even the primary cause of an injury in order for that act to be considered the proximate cause of the injury: rather, it need only be a substantial cause of the injury. The issue of whether a treating physician acted in a reasonably prudent manner must be determined for each individual physician who is a defendant in a medical malpractice action. This is inconsistent with the notion that only physicians who are the primary cause of a patient’s injury may be the proximate cause of that injury – a physician who is not the primary cause of a patient’s injury may nonetheless be liable for that injury: otherwise, there would be no reason to analyze the behavior of each physician individually.
The Florida Supreme Court stated that in order to foreclose liability on the grounds of causation, the defendant anesthesiologist’s acts or omissions must not have substantially contributed to the decedent’s death as part of a natural and continuous sequence of events which brought about that result. To obtain a directed verdict on this basis, the defendant anesthesiologist must show there is no competent, substantial evidence in the record which would permit a reasonable factfinder to reach such a conclusion at all.
Source Ruiz v. Tenet Hialeah Healthsystem, Inc., No. SC17-1562.
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